Diagnosis Of Adolescent Idiopathic Scoliosis Research Articles

Advancements in Adolescent Idiopathic Scoliosis Diagnosis: A Focus on Non-Invasive Techniques

Abstract: Adolescent idiopathic scoliosis (AIS) poses a significant health concern, affecting the spinal curvature of adolescents during their growth period. Early diagnosis of AIS is critical for effective intervention and management. However, conventional diagnostic methods often involve repetitive exposure to X-rays, which can lead to radiation-related side effects. This research paper explores the significance of early diagnosis in AIS and emphasizes the utilization of non-invasive techniques, particularly video raster stereography (VRS), combined with deep ensemble neural networks (DNNs) to enhance diagnostic accuracy while minimizing the risks associated with radiation exposure. We delve into the potential of DNNs in analyzing VRS data and compare its efficacy with other machine learning alternatives

On growth and scoliosis

PurposeTo describe the physiology of spinal growth in patients with adolescent idiopathic scoliosis (AIS).MethodsNarrative review of the literature with a focus on mechanisms of growth.ResultsIn his landmark publication On Growth and Form, D’Arcy Thompson wrote that the anatomy of an organism reflects the forces it is subjected to. This means that mechanical forces underlie the shape of tissues, organs and organisms, whether healthy or diseased. AIS is called idiopathic because the underlying cause of the deformation is unknown, although many factors are associated. Eventually, however, any deformity is due to mechanical forces. It has long been shown that the typical curvature and rotation of the scoliotic spine could result from vertebrae and intervertebral discs growing faster than the ligaments attached to them. This raises the question why in AIS the ligaments do not keep up with the speed of spinal growth. The spine of an AIS patient deviates from healthy spines in various ways. Growth is later but faster, resulting in higher vertebrae and intervertebral discs. Vertebral bone density is lower, which suggests less spinal compression. This also preserves the notochordal cells and the swelling pressure in the nucleus pulposus. Less spinal compression is due to limited muscular activity, and low muscle mass indeed underlies the lower body mass index (BMI) in AIS patients. Thus, AIS spines grow faster because there is less spinal compression that counteracts the force of growth (Hueter–Volkmann Law). Ligaments consist of collagen fibres that grow by tension, fibrillar sliding and the remodelling of cross-links. Growth and remodelling are enhanced by dynamic loading and by hormones like estrogen. However, they are opposed by static loading.ConclusionIncreased spinal elongation and reduced ligamental growth result in differential strain and a vicious circle of scoliotic deformation. Recognising the physical and biological cues that contribute to differential growth allows earlier diagnosis of AIS and prevention in children at risk.

Peer Mentorship Enhances Coping in Children, Adolescents, and Young Adults with Pectus Excavatum and Adolescent Idiopathic Scoliosis

Purpose: Children and adolescents and young adults (AYA) with pectus excavatum (PE) and adolescent idiopathic scoliosis (AIS) experience similar journeys regarding pain, body image, and self- and peer acceptance. Peer mentoring may address some of the challenges faced regarding diagnosis and treatment of PE and AIS. Before implementing a mentor program, our hospital noted an increased length of stay (LOS) and difficulty coping in those undergoing surgery for PE and AIS, emphasizing the need for additional support. The purpose of this study was to evaluate the impact of a peer mentor program for children/AYAs with PE or AIS and their parents on coping, pain, and LOS. Design and Methods: This non-randomized controlled trial included a prospective intervention group that received peer mentorship and a retrospective control group that received standard care. Self-reported surveys assessed the effect of the mentor program on coping. Qualitative data on coping were analyzed descriptively. Postoperative pain and LOS were obtained from the health record. Bivariate inferential statistics were used to compare the distribution of pain scores and LOS between intervention and control groups. Results: Children/AYAs, parents, and mentors reported enhanced coping and found peer mentorship beneficial, though it did not have a statistically significant impact on pain or LOS. Conclusions: Peer mentorship facilitates coping in children/AYAs with PE or AIS undergoing corrective surgery. Parents and mentors also perceived benefits. Practice Implications: Pediatric nurses and child life specialists can help children/AYAs, and their families prepare for surgery by connecting them with peer mentors and social support.

Adolescent Idiopathic Scoliosis Surgery: Postoperative Functional Outcomes at 32 Years Mean Follow-Up.

Recent clinical and radiographic studies conducted over short and medium terms have demonstrated positive results in patients undergoing surgery for adolescent idiopathic scoliosis (AIS). However, the absence of long-term data, crucial for comprehending the impact on future quality of life, especially in young patients actively involved in very intense physical activities, remains a gap. This study aims to evaluate long-term functional outcomes in patients who underwent surgery for Adolescent Idiopathic Scoliosis. Patients meeting specific criteria (diagnosis of AIS, age at surgery between 12 and 18 years, and follow-up of at least 20 years) were identified from a large spine surgery center database. A questionnaire using "Google Form" assessed various outcomes, including Visual Analog Scale (VAS) back, VAS leg, Short Form 12 score (SF-12), Scoliosis Research Society 22 score (SRS-22), incidence of spine revision surgery, postoperative high demanding activities (work and sport), and possible pregnancies was sent to the enrolled patients. The authors analyzed the results regarding all patients included and, moreover, statistical analysis categorized patients into two groups based on the surgical fusion performed: Group 1 (non-instrumented technique according to Hibbs-Risser) and Group 2 (instrumented tecnique according to Cotrel-Dubousset). A total of 63 patients (mean age 47.5 years) were included, with a mean follow-up of 31.9 years. Patients were, in mean, 47.5 years old. Group 1 comprised 42 patients, and Group 2 had 21 patients. Revision surgery was required in 19% of patients, predominantly for implant issues in Group 2 (11.9% vs. 33%, p < 0.05). Overall outcomes were favorable: VAS back = 3.5, VAS leg = 2.5, SRS-22 = 3.5, SF-12 Physical Component Summary = 41.1, SF-12 Mental Component Summary = 46.7, with no significant differences between the group 1 and group 2. At 5-years FU, the non-reoperation rate was higher in the non-instrumented group (97.6% vs. 71.4%, p < 0.001). By means of SRS-22, overall satisfaction was 3.7 ± 1.2 on a maximum scale of 5. More than half of women have successfully completed one pregnancy. Most patients (87.3%) maintained regular work activity. Among sport practioners, half returned to the similar preoperative level. This study reveals favorable long-term functional results in adolescent idiopathic scoliosis patients after surgical fusion. Mild to moderate back and leg pain were observed, but overall satisfaction, sport participation, and work activity were high. Surgical technique (non-instrumented vs. instrumented) did not significantly impact long-term results, though the instrumented fusion exhibited a higher revision rate.

Non-Fusion Versus Fusion Surgery in Pediatric Idiopathic Scoliosis: What Trade-Offs in Outcomes Are Acceptable for the Patient and Family?

Vertebral body tethering and other non-fusion techniques for the treatment of pediatric idiopathic scoliosis are increasing in popularity. There is limited physician consensus on this topic as the result of a paucity of published data regarding which patients most benefit from non-fusion strategies. Thus, much of the decision-making is left to patients and parents, who must select a treatment based on their goals and values and the information available from health-care providers, the internet, and social media. We sought to understand patient and family preferences regarding the attributes of fusion versus non-fusion surgery that drive these choices. Patients and families were recruited from 7 pediatric spine centers and were asked to complete a survey-based choice experiment that had been jointly developed with the U.S. Food and Drug Administration (FDA) to evaluate patient preferences. Choices between experimentally designed alternatives were analyzed to estimate the relative importance of outcomes and requirements associated with the choice options (attributes). The attributes included appearance, confidence in the planned correction, spinal motion, device failure, reoperation, and recovery period. The inclusion criteria were (1) an age of 10 to 21 years and (2) a diagnosis of adolescent idiopathic scoliosis in patients who were considering, or who had already undergone, treatment with fusion or non-fusion surgery. Preference weights were estimated from the expected changes in choice given changes in the attributes. A total of 344 respondents (124 patients, 92 parents, and 128 parent/patient dyads) completed the survey. One hundred and seventy-three patients were enrolled prior to surgery, and 171 were enrolled after surgery. Appearance and motion were found to be the most important drivers of choice. For the entire cohort, fusion was preferred over non-fusion. For patients who were considering surgery, the most important attributes were preservation of spinal motion and appearance. Patients and families seeking treatment for idiopathic scoliosis value appearance and preservation of spinal motion and, to a lesser extent, reoperation rates when considering fusion versus non-fusion surgery.

Non-Invasive Assessment of Back Surface Topography: Technologies, Techniques and Clinical Utility.

(1) Background: Frequent exposure to ionising radiation is often used to determine the diagnosis of adolescent idiopathic scoliosis (AIS), a lateral curvature of the spine in those aged between 10 and 18 years, and a treatment plan according to Cobb angle. This narrative review outlines the clinical utility of surface topography (ST), a radiation-free imaging modality. (2) Methods: Publicly available databases were searched to yield literature related to ST. Identified articles were classified based on the equipment used and in order of how it was developed, i.e., historical, recent developments, and state-of-the-art developments. (3) Conclusions: ST is a reliable cost-effective non-invasive technique that provides an alternative to radiation-based imaging to aid with the diagnosis and potential screening of AIS. Several scanning methods are available, which allows ST to be used in several clinical environments. Limitations of inter-reliability and differences of apparatus resulting in variations of data have been noted through this narrative review.

Intraoperative Radiation Exposure in Adolescent Idiopathic and Neuromuscular Scoliosis.

Intraoperative imaging is often used to aid pedicle screw placement during scoliosis operations. Higher rates of cancer and death have been observed in orthopaedic surgeons and radiation technologists, including a fourfold higher rate of breast cancer in female orthopaedic surgeons. The purpose of this study was to evaluate variability in intraoperative radiation during spinal fusions for both adolescent idiopathic scoliosis (AIS) and neuromuscular scoliosis (NMS). A retrospective review of posterior spinal fusion and segmental spinal instrumentation for scoliosis performed by pediatric orthopaedic surgeons from 2017 to 2019 at a single institution was performed. Inclusion criteria included: a diagnosis of AIS or NMS and patients between 8 and 18 years of age. Exclusion criteria included: revision surgery, use of intraoperative navigation, and patients younger than 10 at the time of scoliosis onset within the AIS cohort. Data collected included: preoperative curve, body mass index (BMI), number of levels fused, number of Ponte osteotomies, and fluoroscopy time. One-way analysis of variance tests, Bonferroni post hoc tests, independent t tests, and Pearson correlations were utilized with significance determined at the 95% confidence level (a = 0.05). A total of 148 patients were included in the study. The average fluoroscopy time was 143 ± 67 seconds. Patients with NMS had higher average fluoroscopy times (193 ± 75 s) compared with patients with AIS (129 ± 58 s, P < 0.001). In patients with AIS, fluoroscopy time correlated to the patient's preoperative curve (r = 0.182, P = 0.050). Patients with AIS with fewer than 12 levels fused had significantly less radiation exposure than those with 12 or more levels fused (P = 0.01). When controlling for the number of levels fused, patients with AIS with higher BMIs had significantly greater fluoroscopy times (P = 0.001). In patients with NMS, fluoroscopy time negatively correlated with BMI (r = -0.459, P = 0.009) and positively correlated with a preoperative curve (r = 0.475, P = 0.007). Fluoroscopy times vary greatly during adolescent spinal fusions for scoliosis. Longer fluoroscopy times are correlated with: NMS diagnosis, larger preoperative curve, BMI, and number of levels fused. Surgeons' knowledge of factors affecting fluoroscopy time will increase awareness and may be the first step in decreasing intraoperative radiation risks. Level III; Therapeutic-a retrospective study.

Do Children With Medicaid Insurance Have Increased Revision Rates 5 Years After Posterior Spinal Fusions?

Socioeconomic disparities in musculoskeletal care are increasingly recognized, however, no studies to date have investigated the role of the insurance carrier on outcomes after posterior spinal fusion (PSF) with segmental spinal instrumentation for adolescent idiopathic scoliosis (AIS). A US insurance dataset was queried using the PearlDiver Mariner software for all patients aged 10 to 18 undergoing PSF for a primary diagnosis of AIS between 2010 and 2020. Age, sex, geographic region, number of levels fused, and baseline medical comorbidities were queried. Complications occurring within 90 days of the index surgery were queried using the International Classification of Diseases, Ninth Revision (ICD-9) and International Classification of Diseases, 10th Revision (ICD-10) codes. Revision surgery was also queried up to 5 years after the index PSF. Categorical variables were compared using the Fisher χ 2 tests and continuous variables were compared using independent t tests. All-cause revision within 5 years was compared using the Kaplan-Meier analysis and a log-rank test. Significance was set at P -value <0.05. A total of 10,794 patients were identified with 9006 (83.4%) patients with private insurance and 1788 (16.6%) patients insured by Medicaid. The mean follow-up in the database was 5.36±3 years for patients with private insurance and 4.78±2.9 years for patients with Medicaid insurance ( P <0.001). Children with AIS and Medicaid insurance had a significantly higher prevalence of asthma, hypertension, and obesity. A larger percentage of children with Medicaid insurance (41.3%) underwent a ≥13-level PSF compared with privately insured children (34.5%) ( P <0.001). Medicaid patients did not experience higher odds of postoperative complications; in addition, revision surgeries occurred in 1.1% and 1.8% of patients with private insurance and Medicaid insurance, respectively at 5 years postoperatively ( P =0.223). Despite worse baseline comorbidities and longer fusion constructs, AIS patients insured with Medicaid did not have higher rates of complications or revisions at 5-year follow-up versus privately insured patients. Level III-retrospective cohort study.

Mean platelet volume and neutrophil/lymphocyte ratio in adolescent idiopathic scoliosis: can they be predictive value in diagnosis?

In our study, we evaluated whether mean platelet volume (MPV) and neutrophil lymphocyte ratio (NLR) are predictive values in the diagnosis of Adolescent Idiopathic Scoliosis in patients diagnosed with scoliosis in our clinic. Approximately 15000 patients who applied to our spine outpatient clinic with the suspicion of scoliosis between 2011 and 2018 were reviewed retrospectively. 292 patients were included in the study. The patients were divided into 3 groups. Group 1; control group group 2; group with the possibility of developing scoliosis under follow-upand group 3; the patient group diagnosed with scoliosis. Spinal curvature degrees of the patients were measured using the Cobb method. The MPV and NLR values of the patients were compared with the degree of curvature measured by the cobb method. NLR was 2.17 ± 2.10 K/ul in Group 1, 2.42 ± 1.76 K/ul in Group 2, and 2.72 ± 3.91 K/ul in Group 3. Although the NLR of the 3rd group was higher than the other 2 groups, it was not statistically significant. (p &gt; 0.05). MPV was 7.90 ± 1.07 fL in Group 1, 7.95 ±1.39 fL in Group 2, 8.33 ± 1.37 fL in Group 3.MPV was higher in Group 3 and was found to be statistically significant (p=0.024). After adjusting for the effects of gender and age variables on the groups, the difference in MPV between groups became more significant (p=0.017) . While there was no statistically significant difference between the groups in terms of NLR, it was observed that MPV was statistically significantly higher in patients with AIS.Could this relationship be a promising inflammatory marker for AIS? We think that this question should be answered by studies involving larger patient and control groups.

Idiopathic adolescent scoliosis and obesity: prevalence study.

Adolescent idiopathic scoliosis (AIS) is a three-dimensional spinal deformity that affects 5% of the population. This pathology has multiple known etiological factors such as family predisposition, female gender, low body mass index, decrease in lean and fat masses. However, recent studies suggest that ciliary dysfunction could be the origin of certain types of obesity and AIS. This study aims to verify the existence of a link between these two pathologies. A retrospective, cross-sectional, descriptive and monocentric study, based on a cohort of adolescents with obesity treated in a paediatric rehabilitation centre for specific care between 1 January 2010 and 1 January 2019. The prevalence of AIS was calculated by radiographic measurements. The diagnosis of AIS was established if the Cobb angle was ≥ 10°, associated with intervertebral rotation. 196 adolescents with obesity were included in the study (mean age 13.2years, mean BMI 36kg/cm2, gender ratio 2.1 of female to male.) The prevalence of AIS in adolescents with obesity was 12.2%, twice the prevalence of AIS in the general population. The characteristics of AIS in adolescents with obesity are predominantly female, 58.3% left thoracolumbar or lumbar principal curvatures, mean Cobb angle 26° and progressive in 29% of cases. Our study established a correlation between AIS and obesity with a higher prevalence than in the general population. The morphology of these adolescents makes screening for AIS more difficult.

Perioperative multimodal analgesic injection for patients with adolescent idiopathic scoliosis undergoing posterior spinal fusion surgery.

This retrospective cohort study compared postoperative as-needed (PRN) opioid consumption pre and postimplementation of a perioperative multimodal analgesic injection composed of ropivacaine, epinephrine, ketorolac, and morphine in patients undergoing posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS). Secondary outcomes include pain score measurements, time to ambulation, length of stay, blood loss, 90-day complication rate, operating room time, nonopioid medication usage, and total inpatient medication cost before and after the initiation of this practice. Consecutive patients weighing ≥ 20kg who underwent PSF for a primary diagnosis of AIS between January 2017 and December 2020 were included. Data from 2018 were excluded to account for standardization of the practice. Patients treated in 2017 only received PCA. Patients treated in 2019 and 2020 only received the injection. Excluded were patients who had any diagnoses other than AIS, allergies to any of the experimental medications, or who were nonambulatory. Data were analyzed utilizing the two-sample t-test or Chi-squared test as appropriate. Results of this study show that compared with 47 patients treated postoperatively with patient-controlled analgesia (PCA), 55 patients treated with a multimodal perioperative injection have significantly less consumption of PRN morphine equivalents (0.3mEq/kg vs. 0.5mEq/kg; p = 0.02). Furthermore, patients treated with a perioperative injection have significantly higher rates of ambulation on postoperative day 1 compared with those treated with PCA (70.9 vs. 40.4%; p = 0.0023). Administration of a perioperative injection is effective and should be considered in the perioperative protocol in patients undergoing PSF for AIS. Therapeutic Level III.

Test characteristics of rasterstereography for the early diagnosis of adolescent idiopathic scoliosis.

This study aimed to evaluate rasterstereography of the spine as a diagnostic test for adolescent idiopathic soliosis (AIS), and to compare its results with those obtained using a scoliometer. Adolescents suspected of AIS and scheduled for radiographs were included. Rasterstereographic scoliosis angle (SA), maximal vertebral surface rotation (ROT), and angle of trunk rotation (ATR) with a scoliometer were evaluated. The area under the curve (AUC) from receiver operating characteristic (ROC) plots were used to describe the discriminative ability of the SA, ROT, and ATR for scoliosis, defined as a Cobb angle > 10°. Test characteristics (sensitivity and specificity) were reported for the best threshold identified using the Youden method. AUC of SA, ATR, and ROT were compared using the bootstrap test for two correlated ROC curves method. Of 212 patients studied, 146 (69%) had an AIS. The AUC was 0.74 for scoliosis angle (threshold 12.5°, sensitivity 75%, specificity 65%), 0.65 for maximal vertebral surface rotation (threshold 7.5°, sensitivity 63%, specificity 64%), and 0.82 for angle of trunk rotation (threshold 5.5°, sensitivity 65%, specificity 80%). The AUC of ROT was significantly lower than that of ATR (p < 0.001) and SA (p < 0.001). The AUCs of ATR and SA were not significantly different (p = 0.115). The rasterstereographic scoliosis angle has better diagnostic characteristics than the angle of trunk rotation evaluated with a scoliometer, with similar AUCs and a higher sensitivity.

Advancing Use of DEXA Scans to Quantitatively and Qualitatively Evaluate Lateral Spinal Curves, for Preliminary Identification of Adolescent Idiopathic Scoliosis

Dual-energy X-ray absorptiometry (DEXA) scan is an emerging screening method for identifying likely adolescent idiopathic scoliosis (AIS). Using DEXA in an unbiased population sample (the Raine Study), we aimed to report the inter-rater reliability and minimal detectable change (MDC95) for scoliosis curve angle measurement, identify likely AIS prevalence, and the concordance between reported AIS diagnosis and DEXA-identified likely AIS. Scoliosis curve angles were measured using the modified Ferguson method on DEXA scans (n = 1238) at age 20 years. For curve angle inter-rater reliability, two examiners measured angles (6–40°) on 41 scans. Likely, AIS was determined with quantitative and qualitative criteria (modified Ferguson angles ≥ 10° and expert review of spinal curves).The inter-rater reliability for scoliosis curve angle measurement was good–excellent (ICC: 0.82; 95% CI: 0.71–0.89; p < 0.001), and MDC95 was 6.2°. The prevalence of likely AIS was 2.1% (26/1238). Diagnosis of AIS was reported despite little or no scoliosis curve (< 3.8°) for 20 participants (1.6%), and diagnosis of AIS was not reported despite scoliosis curve ≥ 10° for 11 participants (0.9%). Results support the use of modified Ferguson method to measure scoliosis curve angles on DEXA. There is potential utility for using a combination of quantitative measurement and qualitative criteria to evaluate DEXA images, to identify likely AIS for reporting prevalence. Without formal school screening, the analysis of DEXA in this population sample suggested that relying on current health professional diagnosis alone could result in 2.5% of this cohort being at risk of false positive diagnosis or delay in necessary management due to non-diagnosis of AIS.

Sports participation reduces the progression of idiopathic scoliosis and the need for bracing. An observational study of 511 adolescents with Risser 0-2 maturation stage.

In clinics and the literature, there are doubts about the indications and contraindications of sports to support rehabilitation treatment for adolescents with idiopathic scoliosis (IS). The aim of the study is to assess sports activities' effect and frequency in a large population of adolescents with idiopathic scoliosis (IS). Retrospective observational cohort study. Tertiary referral institute specialized in the conservative treatment of scoliosis. consecutive patients in a clinical database of age ≥10, with juvenile or adolescent IS diagnosis, 11-25° Cobb curve, Risser Bone Maturity Score 0-2, no brace prescription, radiographic follow-up radiographs at 12±3 months. At 12-month follow-up, radiograph, we considered progression an increase of scoliosis curve ≥5° Cobb and failure an increase to ≥25° Cobb - need of a brace. We calculated the Relative risk (RR) to compare the outcome of participants performing sports (SPORTS) or not (NO-SPORTS). We run a logistic regression with covariate adjustment to assess the effect of sports participation frequency on the outcome. We included 511 patients (mean age 11.9±1.2, 415 females). Participants in the NO-SPORTS group showed a higher risk of progression (RR=1.57, 95% CI: 1.16-2.12, P=0.004) and failure (RR=1.85, 95% CI: 1.19-2.86, P=0.007) than participants in SPORTS. Logistic regression confirmed that the more frequent the sports activities, the less probable progression (P=0.0004) and failure (P=0.004) were. This study shows that sports activities have a protective role against progression at 12-month follow-up in adolescents with milder forms of IS. Excluding high-level sports activities, the risks of progression and failure decrease with the increase in sports frequency per week. Albeit non-specific, sports can help in the rehabilitation of patients with idiopathic scoliosis and reduce brace prescription.

Knowledge and management of adolescent idiopathic scoliosis among practising physiotherapists

It is essential for physiotherapists, who have an important role in the management of adolescent idiopathic scoliosis (AIS), to have adequate knowledge about AIS. Therefore, in this study, we aimed to evaluate the competency of a group of practicing physiotherapists in AIS in Türkiye. A total of 168 physiotherapists working in different health centers between September 2021 and December 2021 were included in the study. The data of this descriptive study were collected with the help of an online questionnaire. The online questionnaire regarding AIS consists of 20 questions prepared by the researchers after the literature review on this subject. Most of the participants were able to correctly answer the questions asked about AIS, including the definition (87.5%), the unknown etiology (72.6%), the age at which it occurs most often (81.5%), how the diagnosis of scoliosis was made (59.5%), the type of exercise recommend (61.3%), when brace can be recommended (73.8%). However, the knowledge level regarding the frequency of idiopathic scoliosis among all scoliosis cases was low (36.3%). AIS-related knowledge level scores of physiotherapists in age and years of clinical experience groups were similar (p&lt;0.05). In addition, male physiotherapists working in a training and research hospital and dealing with a small number of AIS patients had significantly lower levels of AIS-related knowledge (p&lt;0.05). In conclusion, with 67.5% of students able to answer &gt;70% of the survey questions correctly, we demonstrated that the majority of practicing physiotherapists have a good level of knowledge about the definition, diagnosis, and management of AIS; however, some topics need to be improved with some theoretical and practical training after graduation. Physiotherapists need to be improved with some theoretical and practical training after graduation.

Risk factors for vertebral bridging in residual adolescent idiopathic scoliosis with thoracolumbar/lumbar curves

BackgroundAlthough vertebral bridging in residual adolescent idiopathic scoliosis (AIS) can make corrective surgery more complicated, no study has investigated the risk factors. The purpose of this research was to determine risk factors for vertebral bridging in individuals with residual AIS with thoracolumbar/lumbar (TL/L) curves. MethodsForty-two pre-operative patients with residual AIS and TL/L curves (3 males, 39 females: age 41.9 ± 18.0 years) were divided into bridging (n = 17) and non-bridging (n = 25) groups. All patients were 20 years or older with a diagnosis of AIS in adolescence. The bridging group consisted of patients with third or more degree bridging by the Nathan classification. ResultsThere were significant differences in age, absolute value of apical vertebral translation (AVT), C7 translation, and L3,4 tilt between groups. There was no significant difference in TL/L Cobb angle. Multivariate analyses and ROC curves demonstrated that older age was a significant risk factor for vertebral bridging (odds ratio [OR]: 1.08; 95% confidence interval: 1.02–1.14; P = 0.004), with a cutoff value of 38.0 years old. ConclusionsThis study indicates that patients >38 years old are at risk for vertebral bridging in residual AIS. Because of the higher risk of vertebral bridging and other degenerative changes, residual AIS patients about 40 years of age are at a critical point for treatment strategy. Because appropriate surgical time should not be missed, regular follow-up is required even after 30 years of age, especially if the patient with residual AIS has a large TL/L curve indicated for surgery.

The role of school medicine in the early detection and management of adolescent idiopathic scoliosis.

ObjectiveTo analyze the trends in scoliosis screenings over 10 years (2010 vs. 2020). To assess the management of schoolchildren with a preliminary diagnosis of adolescent idiopathic scoliosis by school medicine specialists.MethodsHistorical data were used for the year 2009/2010, and a cross-sectional study was conducted during the school year 2019/2020 on 18,216 pupils of 5th, 6th, and 8th elementary school grades. A forward bend test was used to detect clinical features of scoliosis and some positive findings were referred to orthopedists or physiatrists for further evaluation.ResultsIn the analyzed 10-year period abnormal forward bend test findings increased from 4.9 to 5.8% (by 18.4%; P < 0.001). While its prevalence escalated markedly in girls (from 5.8 to 8.3%; P < 0.001), a modest but significant decrease, from 3.8 to 3.2% (P = 0.018), was noted in boys. Most pupils had low to moderate curves, and its prevalence was some 6.5 times higher in girls (P < 0.001). The forward bend test positive predictive value was 84.7%. Discrete forward bend test aberrations were managed by school medicine specialists only.ConclusionWhile actively promoting scoliosis screening in children, we have shown that forward bend test is an acceptable tool for early adolescent idiopathic scoliosis detection in school medicine. In collaboration with other specialists and using additional diagnostic methods, school medicine specialists can ensure early detection and appropriate interventions, avoiding the potential harms of radiation exposure.

Reliability of a three-dimensional spinal proprioception assessment for patients with adolescent idiopathic scoliosis

PurposeAlthough it is evident that some patients with adolescent idiopathic scoliosis (AIS) have proprioceptive deficit in peripheral joints, knowledge on the proprioceptive function of the deformed spine is limited. Nonetheless, spinal proprioception in AIS may be affected three-dimensionally, prior studies only focussed on evaluating peripheral proprioception in single plane. Therefore, this study aimed to develop a novel spinal proprioception assessment using three-dimensional motion analysis in patients with AIS.MethodsParticipants were included if they had a primary diagnosis of AIS who did not receive or failed conservative treatments. Three trunk repositioning tests involving flexion-extension, lateral-flexion, and axial-rotation were conducted. A three-dimensional kinematics of the trunk was used as the outcome measures. The proprioceptive acuity was quantified by the repositioning error. The intra-examiner and test-retest reliability were analysed by the intraclass correlation coefficient (ICC).ResultsFifty-nine patients with AIS were recruited. Regarding the trunk flexion–extension test, the single measure ICC showed moderate reliability (0.46) and the average measures ICC demonstrated good reliability (0.72). As for the trunk lateral-flexion test, the reliability of single measure and average measures ICC was moderate (0.44) and good (0.70) reliability, respectively. For the trunk axial-rotation test, the single measure ICC indicated fair reliability (0.32), while the average measures ICC showed moderate reliability (0.59).ConclusionThis is the first study to evaluate the reliability of novel three-dimensional spinal proprioception assessments in patients with AIS. The trunk flexion-extension repositioning test may be preferable clinical test given its highest reliability.

Spinal disorders and mastication: The potential relationship between adolescent idiopathic scoliosis and alterations of the chewing patterns.

To evaluate mastication in a group of patients with adolescent idiopathic scoliosis (AIS) with a control group, by means of the prevalence of reverse chewing cycles (RCCs). This study included a group of patients (N=32; F=24; M=8; mean age ± SD=14 ± 3 years) with a confirmed diagnosis of AIS and a group of control subjects (N=32; F=24; M=8; mean age ± SD=13 ± 6 years) without spinal disorders. Mastication was recorded with both a hard and a soft bolus, following a standardized protocol, and the prevalence of RCCs was compared between the groups. The prevalence of RCCs was significantly higher in the AIS group, with both a soft and a hard bolus, compared to the control group (P < .001). The results of this study indicate that the presence of AIS influences mastication, one of the main functions of the stomatognathic system. A multidisciplinary approach to these patients may be relevant in providing the best possible treatment outcomes.

Opportunistic assessment of bone density in patients with adolescent idiopathic scoliosis using MRI-based vertebral bone quality

Patients with Adolescent Idiopathic Scoliosis (AIS) have increased prevalence of lower bone mineral density (BMD) compared to healthy adolescents. Our goal was to compare bone density in patients with AIS and a nonaffected control group using an MRI-based vertebral bone quality (VBQ) score. We reviewed 50 consecutive lumbar MRIs of patients with AIS and of 50 nonaffected controls that were matched for age and sex. The VBQ score was calculated and compared between the groups. The VBQ score for the AIS group was 2.5 (SD 0.4) and for the control group 2.1 (SD 0.3) (p < 0.001). Multiple linear regression analyses were performed for control of confounding from body weight, body height, corrected BMI, and Cobb angle. Besides the diagnosis of AIS, there was no variable that was independently associated with the VBQ score. This is the first study to evaluate bone density in pediatric patients with AIS. We found a significant difference in the VBQ-score between patients with AIS and nonaffected controls matched for sex, age, and race. MRI can be used to assess the bone quality in patients with adolescent idiopathic scoliosis.